Episodes
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My friend and RAMHT co-founder, Grady Hannah, had a quick and dirty conversation with two friends today about the thrilling 2025 CMS Physician Fee Schedule. Every year, there is an open comment period on these proposed changes, and this year has some crucial changes for physicians whoâd love to be able to deploy Digital Theraputics in the context of Behavioral Health Disorders.
Thanks for listening. More coverage of this open comment period is coming soon, but here is a quick overview of the issues at stake.
Yes, this is how nerdy we are at baseline. Yes, we talk like this to each other for fun. This time, we recorded it. Yes, I am this boring.
Thank you so much for listening! As a reminder, I have a new book out, and it is available on the Kindle store! Itâs the number one new release in:
Depression
Pharmacology
Humor: Doctors and Medicine
And itâs inching up to #11 on the âjust generally funny booksâ charts. Letâs push this one to number one among all funny-ish books.
Itâs called Inessential Pharmacology. (amazon link)
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Yesterdayâs column was a fine article, but what if you miss my snarky tone while reading it to yourself? Problem? Solved. Dear Readers, here is the podcast version of the aforementioned article!
For those hoping for actual solutions? The AACAP Facts for Families series of guides exist! For example, you can learn how to prepare for your childâs first cell phone. You can also get expert guidance from actual child psychiatry doctors on Internet Use In Children. Or we could follow scaremongering from the Surgeon General? That is also an option.
My ChatGPT prompt:
âPlease generate a scary warning label for social media that the surgeon general could place on social media platforms that would terrify young people into not using social media quite as much.â
Here is the warning label it came up with:
I think we are really getting somewhere.
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Episodes manquant?
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The Frontier Psychiatrists started as a room in on the clubhouse app. One of the enduring pleasures from that era is my friendship with @Psych Fox (Jeremy Fox, P.C.). Heâs a licensed professional counselor, EMDR therapist, and a delight to speak with. This weekâs podcast features a discussion of a paper Jeremy brought to the table:
Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis
The inflation hypothesis posits that more talking about mental health problems leads to more actual problems. We also discuss the role of screening, including my very popular thoughts on the DSM-5-TR Level One Cross-Cutting Measure, as featured in my Osmind EHR, that I use in my work at Fermata.
In our conversation, we evaluated the possible takes on this paper. While Iâm at it, Iâll remind readers that suicide risk assessment is important, and no one does a better job of explaining it than Dr. Tyler Black:
Thank you for listening! Please share this podcast with your friends drop a a 5-star review on Apple Podcasts. It drives discovery like woah.
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The Frontier Psychiatrists newsletter and podcast do a lot of cheerleading for brain stimulationâparticularly accelerated TMS. However, Iâve recently added many new readers and have not explained my favorite brain stimulation approach. The podcast version and a useful transcript are intended for educational value. Also, here is Garfield:
Prior articles on the topic are myriad, but include:
TMS is better than Drugs
TMS Should be Covered by Medicaid
Depression Can Be Over in 5 Days, Replicated
The Science Behind the Best Outcomes In Mental Health
Your Depression Should Be Over Already
My Sickboy Podcast Appearance
And many others!
Thanks for reading, listening, and sharing.
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The Frontier Psychiatrists is a newsletter and a podcast. Most people assume podcast means ârecording a good enough conversation.â Yes, I do those too. I also have a sick fetish for spending way too much time crafting highly produced audio pieces that happen to be podcasts. I think these might need a different name in the futureâwhat happens when species diverge in evolution?
This story is about someone I knowâAlan Emamdee, D.O. A man arrested for a crime he didnât commit. Unlike the A-Team, he didnât get to go on the run and help people unionize in an 80s TV show. Heâs a doctor who suffered through years of a brutal legal process till he was acquitted at trial. The road back hasnât been easy, but he had the tape. This is the first episode.
Itâs worth the listen. Please, share with your friends.
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The Frontier Psychiatrists started as a Creator First show on the ill-fated clubhouse app. One of our favorite guests was the remarkable @Psych Fox (Jeremy Fox, LPC), an EMDR therapist with a passion for working with men around their actual problems. One of those is the loss of normative friendships among menâ15% of men report no close friendships at all. This corrosion of close relationships is an accelerating problem for both individual men and society.
Todayâs episode of the podcast includes both the video above and pushes the audio to the podcast feed!
Prior writing on the value of friendships and what we can do about that includes articles such as:
Itâs important to have Friends
Friends: A How-To Guide
Matthew Perry was Classy
A Conflict of Interest Disclosure Regarding My Picks for SXSW
The Future of Brain Health?
Announcing: May 5th, 2024âŠ
Rapid Acting Mental Health Treatment NYC 2024
(Eventbrite Link)
Itâs a night of thrilling conversations about the future of mental health. It features speakers fromâŠVidera, MDHub, Osmind, Neurosigma, iRxReminder, andâŠLykos Theraputics!
More info to comeâŠbut itâs the second IRL The Frontier Psychiatrists event, and we could not be more excited to have you!
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The Frontier Psychiatrists is a daily health-themed publication. Your authorâs love of podcasting is well established, and today, another from the vaults, dating back to the pandemic. In this episode, which I called âThe Wave,â I started getting a little more ambitious in production, and strange in the jagged nature of my storytelling. I interview John Samuels, of WellWorth Advisors, Sonia Patel, of Capsule, and a journalist from the New York Times, as well as folks on my team at the time. Thanks for stepping in the way back machine with me. The pandemic was strange. It shaped us, now, and in the future.
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I know how much my readers love my ongoing coverage of Change Healthcare, and sort of kind of promise to keep dissecting drugs or making fun of myself or whatever it is you find compelling about this newsletter and media empire. Today, however, I will publish a podcast. I had a conversation with @Psych Fox this week, before the ransom was paid, by UHC, about the Change situation. Out of respect to my guest, Iâm going to publish it today.
I also take requests on topics for articles and podcasts, so keep them coming. Thank you for reading and listening. If you are new to the newsletter, prior coverage of the change healthcare cyber attack is available here. and here. and here. and here. and here. and here. and also here. Oh, and with an NFT, here.
An overview of all the things changed as is available in this article from yesterday.
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In this Frontier Psychiatrists Podcast, Jeremy Fox, P.C., And I discuss this remarkable work, as published by Cherian Et. Al. In Nature Medicine. Always love when @Psych Fox can pop in!
We discussed the role of understanding the sample in a research trial and the remarkable potency of Ibogaine, with the additional safety of magnesium to prevent cardiac side effects, in this newly published research.
Thanks for watching and listening, and feel free to share with your friends.
Other excellent psychedelic-themed writers Iâd highlight are Mason Marks at Psychedelic Week and The Microdose .
Prior psychedelic medicine articles here on TFPs include:
Are Psychedelics at Risk of Advertising Enforcement from the FDA?
A Critique of âAll Therapists of MDMA Assisted Therapy Should Take MDMAâ
Psychedelic Medicine for Primary Care?
Dear Psychedelic ExceptionalismâŠ
William Osler, M.D., for Psychedelic Medicine Key Opinion Leader
Psychedelic Medicine Obtains Category III CPT Codes
Psychedelic Medicine Needs to Get More Profit-Focused
Iâm Psychic About Open Comment Periods
Why Medical Use and Spiritual Use Are Different
Please spread the good wordâhealing is coming, and more evidence is needed to understand when and for whom.
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The Frontier Psychiatrists started as a âroomâ on Clubhouse, and in this podcast, I am joined by one of our favorite contributors @Psych Fox ! He joins me today to discuss how employee assistance programs can create the on-ramp to help and what might improve that process.
A sampling of prior articles about employer-based health care is available here:
The Science Behind The Best In Class Outcomes in Mental Health (with Acacia Clinics)
Lawsuits for Health Plans Have Begun
Alcohol Use Disorder is a Disability
A Conversation About First Responder Health With Chuck DeSmith
What is Health Insurance that is ERISA Compliant?
Have Health Benefits Become a Huge Personal Liability for Employers?
How Narrow Networks Can Win for Mental Health Parity
Canât Find a Psychiatrist? Now You Can Sue Your Company!
Why Savings Claims Can Be A Scam
What do Shaggy and Health Insurance Have In Common?
Owenâs Letters to the Healthcare Hackers
I want to mention that another validated vendor in the mental health arena is joining my team at Acacia Clinics to have independent validation of our claims of being the best! Iâm thrilled that my friends at Spring Health have achieved the coveted âsavings validationâ from Validation Institute!
If you have been following the news of ERISA enforcement, this is important news. Employers need to get serious about providing better healthcare at a lower cost. Independent validation takes some pressure off when selecting the right vendors to make up a high-performing health plan. Why do I care, as a doctor, about health plans? Because great health plans are better for patients!
Here on substack, Wendell Potter and Marshall Allen are on this beat as well, and Iâd recommend a read!
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I checked in with Jeremy Fox, P.C., about a new FDA-cleared device, the PRISM system by GrayMatters Health. This is a treatment modality for Post Traumatic Stress Disorder that doesn't require talking about your trauma! @Psych Fox is one of my favorite trauma therapists, so I called him to discuss.
This is now offered at four sites in the US, and Fermata in Brooklyn, NY, is one of them. I discuss the experience of having PTSD myself and the role of trauma exposure in medical training and practice.
I do the quick version of explaining the Prism System in 50 seconds hereâŠ
More Jeremy Fox Themed Content:
Bipolar Disorder: Myths Busted
LSD for Anxiety?!: A Podcast
PTSD and EMDR: A Podcast
People I Mostly Admire
Some Other Content About Trauma:
The ICU is Traumatic For Everyone
The Once-Suicidal Psychiatrist
So, Someone Has Been Stalking You?
What Should Parents Say About Mass Shootings?
Being Shot With a Gun is the Leading Cause of Death Among Children In America
A special thanks to the team at Graymatters Health, who visited our offices for deployment this past week!
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This article was among my most popular. Here it is, in podcast format. Enjoy!
Other articles relevant to bipolar disorder include:
Depakote
Is Bipolar Disorder a Circadian Rhythm Disorder?
Lamotrigine (Lamictal) dosing guide.
Does Lithium Prevent Suicide in Bipolar Disorder?
Lurasidone (Latuda)
Ziprasidone (Geodon)
Risperidone (Risperdal)
Why Donât You Drink?
Zyprexa (Olanzapine)
The Time I Almost Set Myself on Fire
Bipolar Disorder: Myths Busted
Thanks for listening, and consider becoming a subscriber.
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The Frontier Psychiatrists didnât start as a newsletter. It began as a clubhouse room, with friends like @Psych Fox and Michelle Bernabe, RN joining myself and Carlene MacMillan, MD for audio-only conversations. Even before that, I was a bit podcast-obsessed. I won a grant to record podcasts about self-disclosure among health professionals at NYUâthe Rudin Fellowship in Ethics and Humanities. This episode is built on a recording from that eraâ2017âwith Gillian Waldorf, Ph.D. This is what I looked like way back in college:
She is a classmate of mine from Amherst College, and we were both huge nerds who didnât drink. Little did we know, we also had our first stirrings of psychiatric illness in common. This podcast is not perfect. It is also only part one. But perfect, as this newsletter + associated media is fond of embodying, is the enemy of the done. This was recorded, edited, and scored by yours truly, Owen Muir, M.D.
I hope you enjoy it. Please share and review on Apple Podcasts if you do!
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The Frontier Psychiatrists is a substack-hosted media empireâŠwe have video, newsletter, dumb memes, podcasts, and musicâmy gosh golly! Today, I bring you a conversation with a colleague who is both humble and brilliant. We first met on Clubhouseâin 2020âwhen Carlene MacMillan, MD and I were hosting conversations on the weekly. Tony and I met again in the What If Ventures fellowship, and, as I have told him, we just enjoyed each otherâs company.
We collaborated on grant writing, and one thing led to anotherâŠand now Iâm the Chief Medical Officer of his company, iRxReminder. Anthony is a kind and funny person to work with, which I couldn't value more highly. He is also brilliant. He understands medication adherence problems better than anyone Iâve ever encountered. In this long overdue podcast, he explains the problem and how we address it with our closed-loop AI + Internet of Things cognitive prosthesis. Heâs a master educator, friend, and my CEO (in one of my gigs)!
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The Frontier Psychiatrists started as a room in Clubhouse, and one of the people who made that awesome was Jeremy Fox, P.C. He joins me today for this video podcast to chat about the groundbreaking phase IIb data released by Mind Med today:
MM-120 100 ”g â the dose achieving the highest level of clinical activity â demonstrated a 7.6-point reduction compared to placebo at Week 4 (-21.3 MM-120 vs. -13.7 placebo; p
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Ramon Lizardo, M.D., and I met at least two years ago when he was an investor, and I was pitching him⊠something. Weâve become friends. In this conversation, he reveals that while he was busy building fabulously successful healthcare companies, he was also going deaf. The audio isnât greatâŠwhich I am going to consider âironyâ kicking my ass. But heâs a fascinating human, and Iâm a big fan. It ends with some remarkable insights into parenting. Thanks for joining the Frontier Psychiatrists today!
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Welcome to the Frontier PsychiatristâŠ. Podcast. It's a podcast with myself, Dr. Owen Muir, as your host, and it's a companion podcast to FrontierPsychiatrist.com, a sassy Substack about health-related things.
This is a conversation between Jazz (Glastra) and me. She is the senior director at Brain Futures, which is a 501c3 not-for-profit. She got to be the interviewer in this one! Iâm a big Jazz fan, as a person, in full disclosure. I also enjoy the art form of the same name, but that is a different story.
We are thrilled to have BrainFutures as partners in sponsoring Rapid Acting Mental Health Treatment 2024. Itâs in San Fran on the 7th of January! Join us! (that is a ticket link!)
In this conversation, we try to get to a shared understanding of what we actually might mean by mental health, the mental health crisis, and whatnot. This means accepting that other people's minds might not be thinking the same things that we're thinking, and so trying to get to the same understandings is a process that we have to take seriously. We need to build trust, and that's really, at the end of the day, what this conversation is about.
The transcript followsâŠ
Jazz Glastra
I'm Jazz Glastra, and I'm the Senior Director at Brain Futures, which is a nonprofit that advances access to new treatments and technologies in brain health.
Owen Muir, M.D.
I'm Owen Scott Muir. I'm a child, adolescent, and adult psychiatrist by board certification. I identify as an interventional brain medicine doctor because I don't really love... the branding of psychiatry or the expectations. Much of this goes back to me constantly thinking about the role of trust and expectations in any conversation.
Jazz Glastra
What is the difference between a neurological disorder, a psychiatric disorder, and a neuropsychiatric disorder?
Owen Muir, M.D.
In the beginning, there were only humors. And that's a little bit of a joke, but We had neurology as a medical specialty,
Sigmund Freud, whom we think of as a psychiatrist, was a neurologist. Because we didn't have psychiatry as a separate medical discipline, to this day, the American Board of Psychiatry and Neurology is one board, ABPN.
What ends up in what bucket in medicine has a lot of historical ness to it? Neurology used to be all of it? If it was a brain or a nerve, That was neurology, and then Freud came along with an explanatory model for problems people had that didn't involve localizing the lesion,? Neurology took over things where you could point at where it was, and psychiatry took over things where you couldn't point at where it was. If you end up having a thyroid problem, then you go to endocrinology, and you're not managed primarily by psychiatry. The accident of history is nonlocalizable Neurology ended up as psychiatry.
And here I am, talking all the time about fMRI-guided treatment, so I'm getting myself in trouble. One of the people who brought this bridge back was Dr. Nolan Williams, who trained initially as a neurologist. He did neurology first, then got board certified in behavioral neurology, and that not being enough residencies, he did an entire other residency in psychiatry.
And three board certifications in, he's a neurologist and a psychiatrist, and blah blah blah. It ends up being, âWho's got the most practice in their training program with whatever the problem is to own it.â It's an accident of history is the answer.
Jazz Glastra
So, are we in a mental health crisis?
Owen Muir, M.D.
Yes, in that we have no idea what that means, and we feel very crisis-y about it.
Jazz Glastra
I feel crisis-y about it, usually.
Owen Muir, M.D.
What is mental health? I have no idea. It is the worst term because it means nothing. Which is really good for charlatans and hucksters and bad for people who are suffering. I would agree we're in a mental health crisis if, in the same question, you let me say, are we in a mobility crisis?
Yes. When we only fill cars with water that should have taken gas, that's a mobility crisis, and we can have the same response to the mobility crisis of filling up gasoline-powered cars with water as we do to the mental health crisis. I'd say those are similarly crisis y. The cars wouldn't move.
And you could talk about what a problem it was all day long, but the car still wouldn't go because you filled it with water, not gas. That's how I think of the mental health crisis. It's a crisis of misunderstanding; the problem is you don't understand the problem, and then you don't apply the right solutions, and you act like it's a crisis, not an actual understandable and solvable problem.
Jazz Glastra
What do you see as the problem?
Owen Muir, M.D.
If you don't know what a mental illness is, or that there are different ones, and that's important, is there a problem with people who are, for example, dying by completing suicide? Yes. That is one version of looking at the problem.
Is there a problem with people having tremendous suffering? Needlessly throughout their day. Yes. Is there a problem of people being disconnected from each other and hopeless? Yes. Is there a problem of death by drug overdose? Yes. Is there a problem of many people feeling anxious and worried? Yes. Is there a problem? Many people are traumatized and thus have sequelae of that problem.
A lot of different problems. Schizophrenia. Homelessness. Having a poor definition for a problem creates. More problems than accurately understanding?
And so my argument is for starting with understanding and saying okay, if the problem is defined as X, then what? Because the mental health crisis doesn't define anything enough for me to have an answer for you.
Jazz Glastra
You gotta do something!
Owen Muir, M.D.
We have to do something is one of the worst things for anyone who's not a huckster.
If you are a huckster, it's great because just misdirected energy to do something âcomma,â anything is a cash grab, and that's awesome.
Jazz Glastra
I think what people probably mean when they say there's a mental health crisis is like the old adage about recessions versus depressions, where a recession is when your neighbor loses their job, and a depression is when you lose your job. When people say there's a mental health crisis, they mean that my immediate family and friends are suffering. People know more people who are struggling or in crisis.
Maybe the question could be, is the incidence of diagnosable mental health conditions rising? Is the incidence of completed suicide rising? Are all these things you listed before, are they getting worse?
Owen Muir, M.D.
Yes, completed suicide is measurable and well-tracked, and definitively, more people are dying by suicide in the United States, at the very least, now than previously. Yes.
Jazz Glastra
What do you think about the term death of despair?
Owen Muir, M.D.
I think it's an attempt at good branding.
It's lumping togetherâdeath from overdose, death from suicide, and death from alcohol use disorder. Death from problems associated with psychiatric illness is an attempt to draw a circle around something in a way that.
It is trying to be helpful. I appreciate both attempts to understand and define a problem. Does that definition empirically hold up? Nate Silver doesn't think so. And Nate Silver is good at numbers.
Jazz Glastra
What's the difference between being in remission and being cured? Why don't you ever hear people talking about cures and mental health?
Owen Muir, M.D.
We don't use the word cure because, essentially, the FDA won't let us. I'm a doctor, saying the word cure has a very specific meaningâdefinition, which is more rigorous than the dictionary definition.
So, the dictionary definition of cure is having âno signs or symptoms of a disease.â I would argue many of the things I do to treat, say, depression, Stanford accelerated intelligent neuromodulation as an example, leads to what could be defined as a cure. However, because of years of hucksterism, We had too many things offered up as cures that weren't.
You end up having to asterisk yourself into incoherence. Could it come back? Yes. I have athlete's foot powder that says it will cure athlete's foot. But that claim was adjudicated by the FDA a long time ago. Meconazole nitrate, a cure. That's a claim on a treatment that they would have to approve. And saying cure makes you sound like a charlatan. Until the FDA agrees with the label that says cure, I'm not going to say cure. Even though people would love that.
Remission is defined as... no signs or symptoms of a disease, which is different from recovery, which I prefer conceptually, which is no signs or symptoms of a disease. And At least one meaningful friendship outside the family and meaningful work or school.
Jazz Glastra
You're getting more into well-being and just whole-person wellness territory there.
Owen Muir, M.D.
I do we need to use that many words to say human? Life anyone would want?
Jazz Glastra
Is that the purview of a psychiatrist or a neuropsychiatrist?
Owen Muir, M.D.
If you imagine the job of a physician stops at no signs or symptoms of a disease no. If you imagine the job of a physician is to help people. optimize full, rich, fulfilling lives and get and stay well, then yes. I tend to be in the latter camp. It's a little bit like trauma surgeons doing advocacy work to reduce gun violence,
they got really good at sewing up bullet holes, but would rather do less of that, thanks. Because there's only so much you can do in the O. R. I trained in Rochester, for med school, where the trauma surgeons were working with the police in the community to set up shot spotter systems and educate youth about gun violence âŠto reduce the number of bullet holes they'd have to sew up. Trauma surgeons have been thinking about how to do this in the community better than psychiatrists have, by a lot, would be my argument.
Jazz Glastra
I've seen this stat bandied about that something like psychiatry hasn't had a new class of drugs in 30 years or 50 years. And we've been doing all this work and research, but the mortality and morbidity rates. are not coming down in our discipline. So I want to know what you think about why psychiatry has been stuck in this rut for so longâŠ
Owen Muir, M.D.
2023 is a year when new things have come to market. The job of a physician is to understand first and then offer treatment help,
We have an entire medical discipline called Physical Medicine and Rehabilitation, which looks to help people restore their physical functioning. And it's called Physiatry, the actual name of the discipline. Now, Psychiatry. is restoring the function of one's mind and psyche, right? And physiatry helps you move your knee.
Whether it's referring you to a physical therapist, or a psychiatric therapist, or a psychological therapist, or, the right number of walks for you, or a medicine to make the walks easier, I see those as very similar. We have a real dichotomy between functional problems, like problems of how something moves over time, and kind of structural problems.
And it's a lot easier to think your arm is broken, let's fix it, than the way your arm moves is broken, let's fix it. Or the way you think about something is broken, let's fix the movement of your thoughts. such that they function better in your life. And, GI gets this, PM& R is a whole discipline for this, and orthopedic surgery is not the same as physical medicine and rehabilitation, but they both deal with that back pain.
Jazz Glastra
Why has innovation been so hard in behavioral health?
Owen Muir, M.D.
We Changed the term to behavioral health and mental health. Whenever we feel uncomfortable, we come up with a new label for what we're doing. None of them are as good as feeling okay. Do you need behavioral health care? I don't know. Do you want to have a good life?
Oh yeah. Are you freaking out? Definitely, I'd like that to stop. Part of the problem is, again, a lack of definitions. Dan Carlin at Mind Medicine Now would say, We spent 30 years perfecting algorithms to make drugs as safe as water. And we got a generation of compounds with the efficacy profile of water. We were obsessed with errors of commission, like we didn't want to do any harm. It's in the Hippocratic Oath. But we also didn't want to risk helping people. Not too much, anyway. Which is an error of omission. We weren't willing to call a spade and to admit that the suffering we were seeing was unacceptable.
And could you do something about it? We limited ourselves only to things that were not harmful, which excluded many things that might have been helpful. Thus, our vision was narrowed. And so if your expectation is, let's pursue treatments that might get people 50 percent better, you're not going to only look at things that get you a hundred percent better. If your endpoint is remission, and that's all you'll accept, then you spend your time on different stuff. So, we spent our time on half measures because it made sense to do so given the constraints we set for ourselves, which were flawed.
Jazz Glastra
How unusual do you think that focus on remission is in your field?
Very rare. If you don't know it's possible, then why would you do it?
Jazz Glastra
Do you think most of your colleagues don't know what's possible?
I think they know it's possible, but they don't have it, as that's not the expectation. Look, I have drugs to prescribe. I'm a prescriber. I'm going to prescribe them. Those drugs are evidence-based, but to do what? To reduce suffering by 50%. Not studied to eliminate all the symptoms of the much less, heaven forbid, something that could get you even better.
Jazz Glastra
So you and I chatted a little bit this week about the prevention of mental health and substance use disorders, mostly mental health disorders, I think. I'm curious if you could talk about wanting to reduce suffering but not eliminate it.
Owen Muir, M.D.
One of the reasons I worry about Eliminating disorders as someone who's enthusiastic about doing so, there's a reason they had a predisposition to have that problem in the first place.
It is like having a Lamborghini as your car but moving to Colorado. And it won't perform well up the hill in the snow. In the context of living in Denver in the winter, a Lamborghini is a poorly adapted car, and you are a terrible driver. And so if you imagine everyone just rags on you for how well your car performs, ignoring what car it is, then I'm a terrible driver.
It happens to me because I have a Lamborghini, and there's snow, and it's not a good snow car, right? My Subaru friends will rip on me. I'm just better adapted to driving around L.A. That goes, wow, you can sit on the 405 at five miles an hour in style.
It's a context issue. Some people do better in the cold; some people do better in the heat. That's what we're prepared for. Some people do better in high novelty environments. Some people do poorly in low novelty environments. Some people are very careful. Some people are very reckless.
We need a variety of people around. Unfortunately, some of those people are more vulnerable in some contexts. So in a high cocaine environment, people with the predisposition to be more curious and novelty seeking which often shows up as adhd Are more likely to use and get a lot of reward from cocaine and develop a cocaine use disorder if you're Some people are predisposed to have a problem in a context, some people gain more weight from McDonald's and you put them in a high McDonald's environment, they get obese.
Some people are more likely to become depressed when things get bad, and they're more likely to be depressed in a highly depressogenic environment. It's our pre-existing vulnerabilities, which are boons in other contexts. You want some people around who are more curious and look under the rock for the extra thing because they can't help themselves. We evolved together in a tribe, and when you lose track of the fact that we need each other, each of these individual vulnerabilities. Thus, I don't want to think about eliminating people with mental illness.
I do want to eliminate the distress. People have, and sometimes that means environmental modifications. And sometimes, it means acknowledging that this environment is one in which you are maladapted. We need to be able to help you function better in this very difficult environment in which you find yourself.
But there's a classic ad for Valium that I think makes us cringe now but should. And it's a woman in a broom closet. âWe can't eliminate her drudgery; we can help the anxiety. Valium,â or some such thing. It's a woman with a rag on her head, and like a bunch of brooms, and it's super sexist.
And it's just ugh. You make, you want to die, and no, stop doing that! Stop, let me, but not everyone has that option. It's about being honest with ourselves. We could eliminate anxiety or make the world a better place so people wouldn't feel trapped. And I don't know that eliminating anxiety is the goal so much as can you, can we help you be untrapped?
Jazz Glastra
We don't need to eliminate people who have a predisposition to anxiety, depression, or schizophrenia, But could we prevent them from having their disorder triggered?
So, I will give you one of the easiest examples of this I can come up with, which is cannabis and schizophrenia. So we have really strong data, mostly from Christoph Carell's work with other people as well, that ultra-high risk for schizophrenia individuals who smoke cannabis are highly more likely to convert to schizophrenia. And so if you wanted to prevent schizophrenia, the easiest thing to do, in quotes around the word easiest, is get young people not to smoke any cannabis. That would prevent a lot of schizophrenia. Good luck with that, by the way.
Jazz Glastra
I think we can have a separate conversation about public health messaging around schizophrenia and cannabis and how effective it could be.
Owen Muir, M.D.
You could prevent schizophrenia by reducing the rates of cannabis use.
Jazz Glastra
I think that would be a nice thing.
âfinâ
Thank you for listening to the Frontier Psychiatrist podcast. Leave us five stars on whatever platform you're listening to. It helps discovery and lets other people know that it's a great podcast. I highly recommend sharing it with your friends. If you have enemies to whom you would like to send podcasts, you can do that too.
If you've enjoyed hearing Jazz and I talk, there'll be more of it. , Brain Futures is co-sponsoring an event I'm hosting on January 7th called Rapid Acting Mental Health Treatment 2024. You can get your tickets on Eventbrite. It's in San Francisco, right before the JPM Health Conference. A special shout out to my friend Grady Hannah, the CEO of Nightware, whose idea it was in the first place.
He and other exciting innovators will be there and talking to each other and to you at this reception. (ticket link)
This is a public episode. If youâd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe -
The Frontier Psychiatrists is a health-themed media empire(!) with a newsletter as its home base here on Substack. It started as conversations on the app Clubhouse, and one of ourâOwen and Carleneâsâ earliest friends is Jeremy Foxâa licensed professional counselor. Heâs a specialist in trauma, an EMDR trainer, and a great explainer of things complex. I also think he is a decent human I love talking to. In this interview, we dig into the neuroscience of EMDRâeye movement desensitization and reprogrammingâfor trauma and more. Please share with your friends, and give the show a follow-up and 5-star review on Spotify, Apple podcasts, etc.
Here is us with the lord of Winterfell, given Winter is Coming. He needs a better coat.
Advertising For Other Things Section!
I work at a practice in NYC for those interested in neuromodulation-first approaches to mental health problems. That means not drugs. Itâs called Fermata.
We are enrolling for the fMRI Guided Depression Trial: The SAINT OLO Study! If you are interested in the treatments we discuss, you can either become a patient or enroll in a research trial, depending on what is right for you. A note: Some of our trials (like SAINT) require payment from patients, and we pay you for others (like TDetect).
This is a public episode. If youâd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe -
Chuck DeSmith is a remarkable manâa King County Firefighter, innovator, and a delightful person for a great conversation. Video Version also available on YouTube channel!
This is a public episode. If youâd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe -
Iâm Owen. This week of posts is different from the usualâŠitâs a bit of an origin story for this newsletter, The Frontier Psychiatrists. Itâs a daily health-themed newsletter by Imperfectionist physician Owen Scott Muir, M.D. There is a podcast (this), videos, a therapy training book, chapters in other therapy manuals, some poetry books, a live event in January, and even a brain-stimulation first clinic in NYC where your depression can be treated in an open-label clinical trialâto remission in 79% of peopleâwithout drugs or talk therapy.
How did all this come to be? That is what this weekâs series of podcasts are the slow-roll story of!
It all started with a podcast about the pandemic. For those listening closely, the last episode was from March 22, 2020. This podcast was recorded the NEXT DAY, on March 23rd. Michelle Bernabe, RN believed in me, and we all need that. Michelle and I were working together at a practice at the time, and the pandemic hit. She is the person who taught me about the heroâs journey and narrative structure. She encouraged me to keep telling a story. The story was about the pandemic at the time. This episode is based on an interview with a nurse struggling to endure the horrors of the early pandemic in New York. As it relates to this newsletter and your author, the story is about the dates. Episode 3 ended, and I was recording Episode 4 the next night. I was dropping perfectionism in the heat of the moment and striving to tell stories that didnât have to be perfect.
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I am, by necessity, becoming an imperfectionist. There is no perfect in a pandemic. Itâs chaos, and perfection stopped being an option.
This weekâs articles tell the story of how I got to write a daily imperfectionist manifesto by showing you how I started telling imperfect stories.
Your feedback, dear readers, is welcome! Thanks for listening, and stay tuned for the next thrilling episode, where I get a bit more ambitious and fall off the wagon a little. Itâs not a linear journey!
Plug 1: I work at a practice in NYC for those interested in neuromodulation-first approaches to mental health problems. That means not drugs. Itâs called Fermata. We are even enrolling for the SAINT OLO Study!
Plug 2: Tickets are available for the Frontier Psychiatrists live event: Rapid Acting Mental Health Treatment 2024, Jan 7th, in San Fransisco!
This is a public episode. If youâd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe - Montre plus
